Six Healthy Habits Can Help Women Avert 73% of CHD: NHS II

Marlene Busko

January 05, 2015

BETHESDA, MD — Adoption of six healthy lifestyle behaviors could avert about 73% of coronary heart disease (CHD) cases among women over 20 years, as well as 46% of diabetes, hypertension, and hyperlipidemia, conclude researchers, based on their analysis of about 69 000 participants followed for 20 years in the Nurses' Health Study II (NHS II)[1].

The optimal healthy-lifestyle behaviors included not smoking, maintaining a lower body-mass index (BMI), engaging in at least 2.5 hours of physical activity a week, watching no more than 7 hours per week of television, and eating a healthy diet. Also included was consumption of up to one alcoholic drink a day; the association between alcohol intake and risks of both CHD and CV risk factors followed a J-shaped curve.

The findings, based on women who entered the NHS II when in their 20s through 40s, were published in the January 6/13, 2015 issue of the Journal of the American College of Cardiology. They reinforce how important it is for young women (and men) to adopt and maintain a healthy lifestyle, lead author Dr Andrea K Chomistek (Indiana University, Bloomington) told heartwire .

"Importantly, adhering to a healthy lifestyle was also associated with a significantly reduced risk of going on to develop heart disease among women who had already developed a cardiovascular disease risk factor such as diabetes or hypertension or hypercholesterolemia," she noted. Further research is needed "to identify the best ways to encourage patients to adopt or maintain a healthy lifestyle."

CAD Not Declining in Young Women

Although overall mortality from CHD has steadily declined during the past 40 years in the US, mortality among 35- to 54-year-olds has leveled off; of more concern, according to Chomistek and colleagues, the mortality among 35- to 44-year-old women increased during 1997 to 2002. They speculate that rising rates of obesity and diabetes may be offsetting reductions in smoking, hypertension, and hypercholesterolemia.

The cohort's 88 940 women were 27 to 44 years old at entry in 1991 and had no CVD or diabetes; 69 347 of the women also had no hypertension or hypercholesterolemia. The women replied to regular questionnaires that assessed lifestyle habits.

The researchers defined optimal BMI as 18.5 to 24.9 kg/m2 and optimal diet as being in the top 40% of the 11-component Alternative Healthy Eating Index-2010. Optimal alcohol consumption was defined as 0.1 to <15 g (about 1 drink) a day, consistent with current guidelines. No current smoking, limited TV watching, and regular physical activity were the other components of a healthy lifestyle.

During the 20-year follow-up, 456 women had an MI and 2749 women were diagnosed with diabetes. A further 16 978 women were diagnosed with hypertension and 23 971 women were diagnosed with hypercholesterolemia. On average, the women were 46.8 years old when they were diagnosed with a CVD risk factor and 50.3 years old when they were diagnosed with CAD.

If all women in this population had adhered to all six lifestyle factors, 92.9% of the cases of diabetes, 57.0% of cases of hypertension, and 40% of the cases of hypercholesterolemia would not have occurred, according to the authors.

Among women with at least one CVD risk factor, Chomistek et al observed, those adhering to at least four optimal health habits had a much lower hazard ratio (HR) for CHD (2.06; 95% CI 1.20–3.52) than women adhering to none of the optimal habits (HR 17.11, 95% CI 9.29–31.52).

Promoting Prudent Lifestyle Choices

"To competent clinicians on the front lines of primary and primordial prevention, these results will not be terribly surprising," Dr Donna K Arnett (University of Alabama, Birmingham) writes in an accompanying editorial[2]. Moreover, exercise, activity, diet, weight, tobacco use, and alcohol consumption "have long been important behavioral targets" in campaigns to lower CVD risk on an individual and population level.

"If the recent trend of rising CHD in young women is indeed true and not a mere blip, then this report is both timely and . . . encouraging: the means to reverse this trend are known," she adds. "All that remains is the task of successfully convincing young adults not to smoke, to exercise more, and to eat and drink prudently."

If there's any hope for doing that, Arnett writes, "it lies in creating a world in which doing those things is the default option. We should thank Chomistek et al for providing another compelling analysis to spur this vision of the future."

NHS II was supported by grants from the National Institutes of Health. Chomistek was supported by an institutional grant from the National Institute of Diabetes and Digestive and Kidney Diseases. Neither the other authors nor Arnett had relevant disclosures.

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